Survivors of cancer with depressive symptoms were twice as likely to die prematurely as survivors who were not depressed, a large, prospective study demonstrated.

To examine the association between depressive symptoms and all-cause mortality among persons who had survived cancer for 1 to 10 years postdiagnosis, researchers issued a questionnaire on depressive symptoms to persons who had received a diagnosis of endometrial or colorectal cancer between 1998 and 2007, or a diagnosis of lymphoma or multiple myeloma between 1999 and 2008. All recipients of the questionnaires had been identified using the Eindhoven (the Netherlands) Cancer Registry.

The individuals who had endometrial and colorectal cancer received the questionnaire in 2008; the lymphoma and multiple myeloma group received it in 2009. Investigator Floortje Mols and colleagues, of Tilburg University in Tilburg, the Netherlands, then obtained the respondents’ later survival status from the Central Bureau for Genealogy (the Dutch information and documentation center for genealogy, family history, and related sciences).

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The median follow-up time from questionnaire completion was 1.93 years for those who lived and 0.96 years for those who died. Between the time of survey completion and March 2011, 251 deaths occurred among the 3,080 persons included in the final analysis (69% of the 4,454 persons originally contacted). Multiple myeloma contributed to the highest proportion of deaths (21.9%); endometrial cancer, the lowest (5.5%).Clinically elevated levels of depressive symptoms were more prevalent in persons who later died compared with those who survived (38% vs 19%). The increased mortality was evident across all different types of cancer.


After adjusting for independent predictors of all-cause mortality, Mols’ team found that people who had survived cancer for 1 to 10 years had double the risk of death (hazard ratio [HR] 2.07). This was also seen among survivors of 1 to 2 years (HR 2.20).

The researchers were able to adjust for metastasis among respondents who had had colorectal cancer. In these patients, too, depressive symptoms increased the risk of death, particularly among 1-to-2-year survivors (HR 2.55, compared with HR 1.88 among the group of 1-to-10-year survivors).

“Paying more attention to the recognition and treatment of depressive symptoms seems warranted since depressive symptoms are often underdiagnosed and undertreated in cancer patients,” concluded Mols and coauthors in Journal of Cancer Survivorship.